This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 14 September 2007

Why am I so Angry?

I am angry because the nursing profession has been destroyed. Nurses are working harder than ever in a rapidly changing environment. Changes in medicine and the way health care is delivered has tripled the workload of hospital nurses. Nurses are caring as well as hard working and we DO CARE about our patients.

The problem is that even the most wonderful, professional, hardworking and caring nurses in the world are not able to cope with their workloads. On average a nurse spends less than 15 minutes with each patient during her 12-14 hour shift. Yet he/she is working so hard that they probably worked 14 hours without eating or even being able to pee. Not only is your nurse working 12-14 hours or more without being able to eat or pee but she is absolutely terrified. Nurse needs to be 10 places at once or someone will suffer or die and nurse gets into big trouble with the law. Patients and visitors want a one to one handmaiden with no concept of how many other patients a nurse has or what is going on with them. Nor do they understand the consequences of the nurse not prioritising correctly. Where are the managers in all this? They are intentionally short staffing the wards knowing full well that the public will take their anger out on the one nurse running her ass off between 30 patients.

Why is this happening? Hospital managers (whether you are in the USA or the UK) only care about money. They are INTENTIONALLY SHORT STAFFING THE WARDS. They are refusing the hire. They don't want to retain their nurses and love to see them burn out and quit. Good nurses are leaving the profession in droves because they are overwhelmed and frightened and cannot stand seeing their patients suffer. I am going to use this blog to focus on these issues. The managers need to be dealt with and the public needs a reality check and they also need to understand what is really going on.

I will start off with asking anyone who has bothered to read this far to look at this petition.

"A growing body of research evidence shows that increases in the number of patients cared for by each nurse leads to increases in hospital-acquired infections, pressure ulcers, malnutrition, dehydration and patient mortality. This also leads to increased levels of stress, demoralisation and "burn-out" among nurses. We therefore feel it is vital to tackle the understaffing of hospital wards. The government should set statutory minimum nurse: patient ratios, with penalties for NHS Trusts that fail to achieve these ratios."

Having set standards regarding staffing not only saves patients lives and reduces complications but it also saves money. Hospitals that have done this have seen their number of complaints plummet. Complaints are a huge expense for the NHS and all hospitals. Hospitals that have implemented this program have also seen their medication and other error rates dramatically decrease. They save more money by having more registered nurses on the wards. Study after study has shown that intentional short staffing by managers is not only dangerous but really very expensive. Registered nurses do make a difference. The managers want as few of them on the wards that they feel they can get away with in order to try and meet their budgets and save money. Having too few nurses around actually has the opposite effect.

Nurses and researchers have known for years that we are not short of qualified nurses...we are short of nurses who are willing to work in hospitals due to the insane and dangerous conditions. These conditions cause nurses to feel overwhelmed and leave. It destroys their health. We train more nurses but we cannot retain them at the bedside due to overwhelming, chaotic and dangerous working conditions. Set nurse patient ratios will allow hardworking nurses to do their jobs and keep nurses nursing. Employing more bedside registered nurses leads to a reduction in expensive patient complications as well as complaints and also saves big money. An astonishing number of qualified British nurses no where near retirement age leave the profession every year due to impossible workloads and increased liability.

If you need to know more and want to see stats and research done on this very subject look here and scroll down: http://www.nursingadvocacy.org/faq/short-staffed.html . If you don't look at this research you probably won't understand what the hell I am on about in this blog.

Nurse are not to posh to wash or too clever to care. We are overloaded and forced to make some really tough deciscions about which one of our multiple patients (who ALL need help now )gets care. Making the wrong decision lands your arse in court and kills someone. Meanwhile all of the "support staff" who have no liability hang around at the nurses station dressed in uniforms nearly identical to ours. That isn't to say that we don't have some excellent support staff that have a very difficult job. My big concern is that the patients/visitors don't know who is who. But that is a whole different topic.

The media and the politicians are abusing and devaluing both doctors and nurses. Yet the doctors are so close minded that they believe that they are the only ones who are the victims of this smear/spin campaign by the powers that be. Doctors jump on the "nurses leave people to lie in their on shit and starve because they don't care" bandwagon just as much as everyone else does. I can forgive the journalists/politicians/and joe public for not having a clue and being ignorant about what's going on with nursing care....but I can't find it in my heart to forgive the doctors. They should know better.

I am also a bit annoyed with former nurses who left the profession in 1982 and haven't been in a hospital since that time who are slagging off the younger nurses. They understand the situation like my hamster understands algebra. It's reality check time. Things are not always as they appear folks.

26 comments:

The simple (and gut churningly awful) answer to all this is that in the main the NHS is more worried about the care of its financial status then the care of the patients.

Nurses are the easy target. The government privatised the support services (cleaners, porters, hostesses etc). That saved some money. But not much.

Then they culled back these staff to save paying for it.

It saved some more.

Then somebody got the accounts wrong, and we work up to be told we were left with a financial black hole the size of Belgium. There was a "financial recovery" plan initiated. While this seems nice, I am left with the distinct impression that all the happened was that a group of people sat around in an office saying things like "ooh" and "crikey".

Then someone called Rupert who was not bright enough to land a job in the city finiance market looked at the accounts and relised there was some money being spent on nurses. Rupert was not very bright indeed, and told the NHS that less nurses means they save money.

They culled nurses. Then still lost money. There was some rumbles from the shop floor which the heared a bit in their sealed ivory tower. Then the physiotherapists and occupational therapists went west in the same manner, but hey, the public would never know right? But still Rupoert lost money.

So why not cull the doctors? "Cull". Hmm...not a palliatable taste...but "modernise".

So they did. Then somebody opened the curtains in the ivory tower showing the desimated landscape of the NHS where nurses are burt out, over worked and the patients up the creek without a paddle.

And until Ruperts mummy happens to snuff it because a nurse was too overworked to care properly, this will continue to happen. Because Rupert know just how expensive patients are to keep in the hospital with costs money, so if we close the beds, wards and hospitals...

Just remember that when Rupert's mummy gets starved to death in hospital he will blame the nurses directly as either to stupid to understand that people need to be fed or to bitchy to care. Idiot.

You wouldn't believe some of the things that are going on at my trust. A newly qualified nurse who on has experience working in medical was sent to work on a surgical ward. She had never been on this ward before, she had no experience looking after surgical patients nor the specialty that they were under, and she was left alone with 15 patients on her own. Poor girl spent half the shift looking for stuff.

They have closed down medical wards but are overwhelmed with medical patients. Therefore they are sending the medical patients and the staff from the closed wards onto the surgical wards. So now we have a mix of medical and surgical patients in each bay. It gets worse and worse I can't even go into detail here. That have managed to get rid off lots of staff nurses and HCA's as well.

How would you like to go into a new specialty on a ward you have never seen before and be responsible for 15 patients on yuour own with no one to bounce anything off of? Come work at my hospital.

Now the surgical wards are full of medical patients who are medically stable but cannot care for themselves and have dementia. They wait months for nursing homes. Months and months. Can't get any of the scheduled surgical patients in now.

The nurses are miserable. The patients are miserable. The managers can't figure out how this little trick hasn't saved more money. Our complaints have increased tremendously since they did this.

Great post! Here's my take on things: I work in a fairly busy ER where leaving in-patients in the ER seems to be the rule of the day. This is a real burden on ER nurses because, unlike the floors, the number of patients continue to increase and those same nurses are required to care for these in-patients, with no nurse to patient ratios that the floors currently use. Thus, if an MI patient arrives and that same nurse has 2 admitted abdominal pains, a back pain and in intractable nausea and vomiting, guess who gets the attention? You guessed it: the MI. This isn't to the in-patients, nor is it fair to the nurse.

We're told that there are no nurses to take care of these in patients, there are no beds available, hospital census is low, thus less staff. Occasionally we'll get a tele flex nurse to care for the in patients, but this is a rarity, and these tele flex nurses don't handle the stress of an ER well because it isn't their forte...

Hello! Militant Nurse Anne - I like your style! You certainly do say it as it is and your post has clarified a great deal. I wrote a post yesterday on Nursing in the NHS (from a patient's perspective) and if I'd known then what you've described here, it would have explained a lot.

You said "Meanwhile all of the "support staff" who have no liability hang around at the nurses station dressed in uniforms nearly identical to ours. That isn't to say that we don't have some excellent support staff that have a very difficult job. My big concern is that the patients/visitors don't know who is who".

I realise now that a lot of the 'nurses' that I saw hanging around were probably actually 'support staff' - this explains my disbelief at their inability to communicate or to function without having to tick a box first. I know that many patients these days give the nurses a really hard time - but others (and I include myself here) really do suffer in silence and their health is definitely compromised.

I had no idea that things were quite as bad for nurses as you describe. I'm not in the least bit surprised that you feel so angry about what's happening to your profession.

I totally agree with you about the situation with hospital managers. We have the exact same problems here in the Irish health service (I used to work in it) which like the NHS, shows all the hallmarks of going into meltdown.

You sound like a brilliant nurse and I apologise if I've offended you with my views on the NHS.

Thanks so much for your comments. I like to hear from patients. I understand that patients are suffering a great deal and that is one of the reasons I started this blog. Not only do I want to blow off steam but I want to open up the lines of communication between patients and healthcare staff since we are all getting burned here.

I really think we all need to get together on a lot of this stuff and that we have a common enemy.

I have a child who suffered life long damange due to a hospital screw up. I also had a close relative who suffered horribly and died as a result of a miscommunication during the course of an illness. Many of us (nurses) do know what it is like to be on the other side so to speak. As a nurse I have personally fucked up in the past (nothing major thank god). At the beginning of every shift I pray that I don't make an error that hurts someone and at the end of my shift I say "there by the grace of god go I". And I was never the religious praying type.

Errors like these occur due to a chain of events that goes to hell early on in the process and much of the time errors occur because of overwhelmed staff rather than staff who is uncaring and lazy.

Yes, you're right, this is happening in the US as well -- I think we perhaps invented it, though for the sake of corporate profits rather than something related to the way the NHS "thinks."

Now we have this major push for more and more EMR - electronic medical record, which means that nurses add the task of wrestling with a computer to enter data about their patients that no one ever reads because you can't get anything comprehensible from the computer -- it's like conceiving of a spreadsheet as literature.

So interestingly enough we have managed in the electronic 21st century to advance medicine to the state of prehistory, where the only useful information is obtained by word-of-mouth.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.